Provider First Line Business Practice Location Address:
12244 OXNARD STREET
Provider Second Line Business Practice Location Address:
#2
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606-4640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-766-3633
Provider Business Practice Location Address Fax Number:
818-980-6368
Provider Enumeration Date:
02/21/2007